Rapid review of public health guidance on protective ... · Wales, Welsh Government Since 24 March, the Welsh government has been following PHE advice on shielding and protecting

Rapid review of public health guidance on protective measures for vulnerable groups Health Information and Quality Authority

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Rapid review of public health guidance

on protective measures for vulnerable

groups in the context of COVID-19

13 July 2020


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Version history

Version Date Specific updates

V1.0 23 March 2020 Date of first rapid review

V2.0 24 March 2020 Review updated:

Updated guidance from Norway, Scotland, and Switzerland included;

‘Live’ table of protective measures in each setting added.

V3.0 25 March 2020 Review updated to reflect change in guidance for vulnerable groups in:

Australia; New Zealand;

Switzerland.

V4.0 26 March 2020 Review updated to include new guidance for vulnerable groups in Singapore.

V5.0 02 April 2020 Review updated to include latest guidance for vulnerable groups from Ireland. Review updated to reflect change in the definition of high risk groups in:

Australia Norway US

V6.0 06 April 2020 Review updated to reflect change in the definition of high risk groups in:

US Scotland

Additional measures/support: UK

Change in advice: Norway

Additional information on vulnerable social groups:

Canada

V7.0 09 April 2020 Minor text added:

Canada Review updated to reflect change in the definition of high risk groups in:

CDC Additional country profiles:

Sweden

Germany

V8.0 16 April 2020 Additional detail added:

New Zealand Minor text added:

Sweden


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Minor layout changes:

Germany

V9.0 20 April 2020 Minor editing in wording used:

Australia Scotland

Reduced list of conditions for higher risk:

Norway Addition of advice for cohabitating with people at higher risk:

Norway UK

V10.0 23 April 2020 Minor layout changes:

Australia Northern Ireland (criteria now listed

separately from PHE)

V11.0 27 April 2020 Review updated to reflect change in the definition of high risk groups:

Sweden Minor additional advice:

Norway

New Zealand

V12.0 30 April 2020 Review updated to include additional detail on conditions of high risk groups:

Switzerland

New Zealand

V13.0 7 May 2020 Review updated to reflect change in the definition of high risk groups:

UK

Sweden Updated Advice:

New Zealand

V14.0 11 May 2020 Review updated to include additional detail on conditions of high risk groups:

Germany Additional information provided for:

Finland Germany


Scotland UK

Updated Advice:

New Zealand Additional advice:

Switzerland



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New Zealand Updated advice:

Ireland


New Zealand Northern Ireland

Updated advice:

Finland

V18.0 25 May 2020 Review updated to reflect change in the definition of high risk groups:

Norway Switzerland

Updated advice:

Norway Scotland

V19.0 2 June 2020 Review updated to additionally include:

Wales Updated advice:

England Singapore

V20.0 8 June 2020 Review updated to reflect change in the definition of high risk groups:

Northern Ireland Norway Singapore Sweden

Updated advice: Northern Ireland

Wales Ireland New Zealand

V21.0 15 June 2020 Updated advice:

Northern Ireland Wales Sweden

Switzerland

V22.0 22 June 2020 Updated advice:

Scotland Canada

V23.0 29 June 2020 Updated to reflect change in the definition of high risk groups:

US Updated advice:

England Ireland


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Northern Ireland Switzerland

US

V24.0 6 July 2020 Minor update in the wording in the definition of high risk:

Scotland Updated advice:

England Scotland

Northern Ireland Wales Finland

V25.0 10 July 2020 Updated advice:

England Scotland Australia


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Table of contents

Version history ..................................................................................................... 2

Table of contents ................................................................................................. 6

Key points ........................................................................................................... 7

Background ......................................................................................................... 8

Methods .............................................................................................................. 9

Results ................................................................................................................ 9

England, Public Health England (PHE) ................................................................ 9

Northern Ireland, Public Health Agency (PHA) .................................................. 12

Scotland, Health Protection Scotland (HPS) ...................................................... 13

Wales, Welsh Government .............................................................................. 16

Australia, Department of Health ....................................................................... 16

Canada, Government in Canada ...................................................................... 17

Finland, Finish Institute of Health and Wellness (THL) ...................................... 18

Germany, Robert Koch Institute (RKI) .............................................................. 19

New Zealand, Ministry of Health ...................................................................... 20

Norway, Norwegian Institute of Public Health (NIPH) ........................................ 22

Singapore, Ministry of Health ........................................................................... 25

Sweden, Public Health Agency of Sweden ........................................................ 26

Switzerland, Federal Office of Public Health (FOPH) .......................................... 28

US, Centers for Disease Control and Prevention (CDC) ...................................... 29

Conclusion ......................................................................................................... 30

References ........................................................................................................ 55


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Key points

A variety of protective measures are being taken to protect vulnerable groups who are at high risk of severe illness from COVID-19 in all countries included in this review.

In general, people included in the vulnerable group categories are those of older age, those with chronic conditions such as diabetes, high blood pressure and respiratory conditions and those in receipt of therapies that weaken the immune system.

Australia, Canada, Finland, Germany, New Zealand, Singapore, Sweden, Switzerland, United States and Wales have a single grouping for vulnerable people, while England, Northern Ireland, Scotland and Norway distinguish between those considered at ‘highest risk’ and those at ‘increased risk’.

Some countries have published additional risk factors that increase risk, although these do not always necessitate inclusion in the vulnerable group category. These risk factors include ethnicity, smoking, high BMI and pregnancy in conjunction with another condition.

Advice for vulnerable groups typically includes stay at home, practice hand hygiene, physical distancing and avoid all contact with others.

For the countries that distinguished high risk from highest risk, proportionate advice is given. This usually means those at highest risk are advised to not leave the house, while those that are an increased risk can leave the house but are strongly advised to practice physical distancing and not meet others.

As some countries have begun to ease restrictions, the advice for people in the vulnerable group has changed to include the choice to go outside. For some countries this has also included meeting people outside of their household, including physical contact with grandchildren.

As of 19 June, all four neighbouring countries of Ireland allow those who are shielding or cocooning to go outside and in specific situations to meet with people from other households. Furthermore, from 1 August, if infection rates continue to be low, PHE will no longer advise those at the highest risk to shield and the shielding programme will be paused. However, the shielding patient list will be maintained by the NHS.


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Background

In Ireland, protective measures are being taken to protect vulnerable groups who

may be at risk of severe illness from coronavirus disease (COVID-19), in particular

extremely medically vulnerable groups. On 27 March 2020, the Health Protection

Surveillance Centre (HPSC) issued guidance on ‘cocooning’ for these groups, which is

a practice used to protect or shield those who may suffer the most from coming into

contact with the virus.(1) The extremely medically vulnerable groups, defined by the

HPSC in Ireland, include:

People aged ≥ 70 years Solid organ transplant recipients People with specific cancers:

o people with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer

o people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment

o people having immunotherapy or other continuing antibody treatments for cancer

o people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

o people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.

People with severe respiratory conditions including cystic fibrosis, severe asthma, pulmonary fibrosis/ lung fibrosis/ interstitial lung disease and severe COPD

People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)

People on immunosuppression therapies sufficient to significantly increase risk of infection

Women who are pregnant with significant heart disease, congenital or acquired.

On 27 March, the specific advice given to these groups was to stay at home at all

times and avoid any face-to-face contact with others. It was announced on 1 May

that those cocooning could go outside for a walk, provided they followed strict

physical distancing and hygiene guidelines. However, avoidance of shops is still

recommended. This was outlined in guidance by the HPSC and includes meeting

people in groups of up to four people outdoors.(2)

On 5 June, as restrictions were eased for the general population, the advice for

those cocooning was updated to include more activities outside the home. These

included measures aimed at minimising the risk of acquiring COVID-19 infection,

such as leaving the home to go for a drive, visiting shops and public services, when

receiving visitors, and for members of the public supporting those who are

cocooning when they are outside their home (see Table 1 for all measures).

Additional guidance has been provided for people cocooning relating to receiving

visitors and making visits to other people’s houses,(3) and also for any person visiting

https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/vulnerablegroupsguidance/COVID-19%20Guidance%20for%20extremely%20medically%20vulnerable%20groups.pdf


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a resident in a residential care facility (with effect from 15 June).(4) As of 26 June, a

physical distancing of 1 or 2 metres with others in the same household, as previously

stated, is no longer specified for those cocooning. In addition, public transport is

advised during off peak only and non-essential care by informal carers, including

family carers, can resume.

Similar measures have been implemented in other settings to protect vulnerable

groups. We undertook a rapid review of public health guidance on COVID-19, to

summarise the range of advice and recommendations that have been issued to

protect vulnerable groups who may be at risk of severe illness from the virus.

Methods

The review was first undertaken on 23 March, in line with the ‘Protocol for the

identification and review of new and updated relevant COVID-19 public health

guidance’, available on https://www.hiqa.ie/areas-we-work/health-technology-

assessment/covid-19-publications. The review was updated twice-weekly and as of

25 May, it is updated on a weekly basis. A detailed account of the methods used in

this review are provided in the protocol.

Results

A number of protective measures have been undertaken in different health care

settings to protect vulnerable groups who may be at high risk of severe illness from

COVID-19. Table 1 provides a ‘live’ overview of the protective measures that are

being undertaken across different countries. A variety of names have been used to

describe the measures which ultimately resemble ‘cocooning’ and involve strict

isolation advice. These include ‘shielding’ and ‘protective self-separation’. The

specific measures that have been undertaken in each health care setting to protect

vulnerable groups, as identified in this rapid review, are summarised separately

below.

The neighbouring countries of Ireland are presented first, including England,

Northern Ireland, Scotland and Wales, followed by Australia, Canada, Finland,

Germany, New Zealand, Norway, Singapore, Sweden, Switzerland and the United

States.

England, Public Health England (PHE)

On 21 March, PHE issued guidance on ‘shielding’ and protecting people who are

clinically extremely vulnerable, including children.(5) On 23 June, it was announced

that unless a significant rise in cases is seen, the shielding programme is likely to be

paused and people who are clinically extremely vulnerable will be advised to adopt

strict physical distancing rather than full shielding measures (see below).(6) As per

PHE, shielding is a practice used to protect clinically extremely vulnerable people

from coming into contact with COVID-19. These people include:

https://www.hiqa.ie/areas-we-work/health-technology-assessment/covid-19-publications

https://www.hiqa.ie/areas-we-work/health-technology-assessment/covid-19-publications

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19



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People who have had an organ transplant People with specific cancers:

o People with cancer who are undergoing active chemotherapy

o People with lung cancer who are undergoing radical radiotherapy

o People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment

o People having immunotherapy or other continuing antibody treatments for cancer

o People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

o People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.

People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD).

People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell).

People on immunosuppression therapies sufficient to significantly increase risk of infection.

Women who are pregnant with significant heart disease, congenital or acquired.

Other people have also been classed as clinically extremely vulnerable, based on clinical judgment and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decisions.

On 31 May, the advice was updated to take into account that COVID-19 disease

levels for England were substantially lower than when shielding was first introduced.

On 19 June, the UK CMOs changed the COVID-19 alert level from level four to level

three following a recommendation by the Joint Biosecurity Centre. This means that

the virus is considered to be in general circulation but transmission is no longer high

or rising exponentially. On 22 June, the government set out a series of steps for

further relaxing shielding guidance, which will come into effect on 6 July and 1

August.(6) From 6 July, people who are advised to shield may if they wish:

meet in a group of up to six people outdoors, including people from different

households, while maintaining strict physical distancing

no longer observe physical distancing with other members of their household

in line with the wider guidance for single adult households (either an adult

living alone or with dependent children under 18) in the general population,

form a ‘support bubble’ with one other household. All those in a support

bubble will be able to spend time together inside each other's homes,

including overnight, without needing to physically distance

All children and young people currently identified as clinically extremely vulnerable,

and advised to shield, should continue to do so until 31 July. It is acknowledged that

the risk is lower in children, as such it is advised that children and young people up

to the age of 18 consult their paediatric specialist or GP to determine the most

https://www.gov.uk/government/news/plans-to-ease-guidance-for-over-2-million-shielding


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appropriate care. Children with conditions including asthma, diabetes, epilepsy and

kidney disease, as well as children who receive specialist care in hospitals, may still

be considered clinically extremely vulnerable following a consultation with their

doctor. This includes those receiving cancer care or those at risk of severe infection

due to an immunodeficiency. For a parent or carer who is shielding, it is advised that

their child only attends education or childcare settings if physical distancing can be

maintained. If this is not possible, they are advised to learn or work at home until 31

July.

From 1 August, the government is advising that shielding will be paused and advice

to those previously shielding will move in line with the current advice to those who

are clinically vulnerable (see Table 1). From then on the advice will be:

to go to work, as long as the workplace is COVID-19-secure , but carry on working from home if possible

children who are clinically extremely vulnerable can go back to school (when the rest of their class goes back)

to go outside to buy food, to places of worship and for exercise, but to keep 2 metres away from others wherever possible.

PHE states that this guidance is still advisory. People in this group will not be fined

or sanctioned if they prefer to follow the guidance on staying alert and safe (physical

distancing).

On 6 April, NHS Digital published details on the process for maintaining the Shielded

Patient List (SPL) - a list of people at ‘high risk’ of complications from COVID-19,

who should be shielded. Patients are eligible based on the criteria for extremely

vulnerable people (above).(7) On 2 June it was announced that given the emerging

evidence and the improving epidemiology, the Government’s Shielding policy is

currently under review.(7) The NHS will maintain the SPL following the pause of the

shielding programme on the 31 July.(6)

The ‘high risk’ list was defined as a subset of a wider group of people who may be

‘at risk’. Specific advice is provided for these groups; currently the advice for the ‘at

risk’ group, which is a large group (approximately 19 million people) who are

normally at risk from the flu, is to practice strict physical distancing; the advice for

the ‘at high risk’ group, which is a smaller sub-group (approximately 1.5 million

people) defined by the Chief Medical Officer (CMO), is to practice complete social

‘shielding’. The SPL is generated from NHS Digital data repositories, and additional

sources, as directed by NHS England and the CMO for England. These include

additional cancer patients and those identified by GP practices and acute hospitals.

In the future, hospital specialists and GPs will be able to add or subtract individual

patients from this register. As of 29 March, all people on this list were to be

contacted by the NHS and extra supports in relation to coronavirus were being made

available: SMS Shielding Service, assistance with food and or prescriptions, food and

essential supplies deliveries (free). This will cease on 31 July.(6) However, people can

continue to avail of priority supermarket slots.

https://digital.nhs.uk/coronavirus/shielded-patient-list



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On 11 May, PHE guidance on social distancing(8) was superseded by Staying alert

and safe (social distancing).(9) Within this guidance, the specific advice for clinically

vulnerable people, as listed below, remained unchanged (that is, to stay at home as

much as possible and, when outside, to take particular care to minimise contact with

others). Clinically vulnerable people are those who are:

Aged 70 or older (regardless of medical conditions) Under 70 with an underlying health condition listed below (that is to say,

anyone instructed to get a flu jab as an adult each year on medical grounds): o Chronic (long-term) mild to moderate respiratory diseases, such as

asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis

o Chronic heart disease, such as heart failure o Chronic kidney disease o Chronic liver disease, such as hepatitis o Chronic neurological conditions, such as Parkinson’s disease, motor

neurone disease, multiple sclerosis (MS), or cerebral palsy o Diabetes o A weakened immune system as the result of conditions, treatments like

chemotherapy, or medicines such as steroid tablets o Being seriously overweight (a body mass index (BMI) of 40 or above).

Pregnant women.

Since 11 May, the guidance for physical distancing measures has been included in

the Staying safe outside your home guidance.(10) Since 11 May, PHE has advised that

those who want to go out to help a vulnerable person can do so provided physical

distancing and hand hygiene is maintained, unless they have coronavirus symptoms,

even if these symptoms are mild.

From 4 July, as the UK government continues to ease restrictions, people identified

as clinically vulnerable can meet people indoors (see Table 1). The guidance Staying

alert and safe (social distancing) is now stated to apply to England only, and for an

area that is experiencing a local COVID-19 outbreak and where local lockdown

measures have been imposed, different guidance and legislation will apply.(9)

Northern Ireland, Public Health Agency (PHA)

From 23 March, the PHA in Northern Ireland was following PHE’s guidance on

shielding for people who are extremely vulnerable. On 23 April, upon advice from

Northern Ireland’s CMO, two additional conditions were added to the list of

extremely vulnerable groups. These included those undergoing renal dialysis and

those with Motor Neurone Disease. On 15 May, in addition to PHE criteria, people

who have had a splenectomy were added to the list (see Table 1).

People in this risk group are advised to stay at home at all times and avoid all face-

to-face contact for at least 12 weeks. On 8 June, the advice was updated to allow

those shielding to go outside with members of their household or, if they live alone,

to meet one other person from a different household and preferably the same

https://www.gov.uk/government/publications/staying-alert-and-safe-social-distancing/staying-alert-and-safe-social-distancing


https://www.gov.uk/government/publications/staying-safe-outside-your-home/staying-safe-outside-your-home




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person each time. On 6 July, the advice was updated to allow those shielding to

meet with up to six people outside of their home, with physical distancing, and if

shielding alone to form a support bubble exclusively with another household, which

includes staying overnight at that household, without the need for physical

distancing measures.(11) However, it is still not advised that people in this group

should attend any gatherings, including gatherings of friends and families in private

spaces, for example, parties, weddings and religious services. From 31 July, it is

anticipated that those who are extremely vulnerable will no longer need to shield

and the shielding programme will pause.(12)

Similarly, for older people and people with an underlying health condition, PHA was

following PHE’s guidance on physical distancing.(8) A link to the criteria is listed on

the NI Direct website,(13) which appears to be based on the criteria used by PHE for

identifying those who are at an increased risk of severe illness from COVID-19 and

those that should practice physical distancing measures. This includes people over

the age of 70, people who are pregnant, and others who have certain conditions

(see Table 1). On 22 March, it was estimated that 40,000 people meet these criteria

in Northern Ireland. On 6 June, people who have motor neurone disease and people

who have problems with the spleen were removed from the vulnerable person

criteria, but remain on the extremely vulnerable criteria. As of 30 June, people in this

group are allowed to meet with others outside the home, or have visitors indoors,

while adhering to physical distancing guidelines.

Scotland, Health Protection Scotland (HPS)

On 23 March, HPS was following PHE’s guidance on social distancing.(8) The

protective measures announced by PHE (on shielding) have also been included in

relevant guidance issued by HPS. On 28 April, there was an estimated 150,000

clinically vulnerable people shielding in Scotland (link).(14)

On 3 April, detailed criteria were provided by the Scottish government for identifying

people considered to be at the highest risk of severe illness:(15)

Solid organ transplant recipients - includes people who have had a transplant of heart, lung, stomach or other part of intestine, liver and kidney. People will be in this group because they need to take medications to prevent rejection of the transplanted organ.

People with specific cancers - made up of five sub-groups: o People with cancer who are undergoing active chemotherapy or have had

radical radiotherapy for lung cancer o People with cancers of the blood or bone marrow such as leukaemia,

lymphoma or myeloma who are at any stage of treatment o People having immunotherapy or other continuing antibody treatments for

cancer o People having other specialised, targeted cancer treatments which can

affect the immune system, such as protein kinase inhibitors or PARP inhibitors

https://www.nidirect.gov.uk/articles/coronavirus-covid-19-advice-vulnerable-people

https://www.gov.scot/publications/coronavirus-covid-19-update-health-secretary-statement-parliament-28-april-2020/

https://www.gov.scot/publications/covid-shielding/pages/highest-risk-classification/


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o People who have had bone marrow or stem cell transplants in the last six months, or who are still taking immunosuppression drugs.

People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe Chronic Obstructive Pulmonary Disease (COPD), severe bronchiectasis and pulmonary hypertension. People in this group include: o All patients with cystic fibrosis o People with severe asthma, having severe asthma and on regular inhalers

AND long-term oral steroid tablets, e.g. prednisolone, OR regular injections to control their asthma

o People with severe COPD, this means being too breathless to walk 100 yards, having two or more lung infections per year or requiring oxygen to help with their breathing. This usually means anyone who has been on several different inhaler medications in the last year. This must include two long acting preventers (Long Acting Beta Agonists and Long Acting Anti-Muscarinic Antagonists) and a steroid inhaler

o People on home oxygen for a lung condition. People with rare diseases including all forms of interstitial lung

disease/sarcoidosis. Also, includes inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell disease) o There are many conditions classed as a rare disease. Not everyone with a

rare disease will be at a higher risk of severe illness from COVID-19. People on immunosuppression therapies that significantly increase risk of

infection. Or who have had their spleens removed. o Immunosuppressive therapy may be used to keep a person from rejecting

a bone marrow or organ transplant. It may also be used to treat conditions in which the immune system is overactive, such as autoimmune diseases and allergies

o In some cases these treatments may put people at a higher risk should they contract Covid-19 infection. The following situations put people into the highest risk group:

patients on high dose corticosteroid treatment (equivalent to Prednisolone 20mg or more) for 4 weeks or more

patients on specific single therapies, for example Cyclophosphamide. These medications are usually prescribed by specialists in hospitals and clinical judgement is needed to determine if medications indicate highest risk

patients on lower dose of corticosteroids (equivalent to Prednisolone 5mg per day for 4 weeks or more), in combination with other disease modifying medication

patients on several different disease modifying medications taking into account their other chronic medical conditions (Patients on a single Disease Modifying medications (DMARD) or Biologic such as Methotrexate, Azathioprine, Cyclosporin, Leflunomide plus others, would not automatically be considered in the highest risk group if they are otherwise healthy, but should be decided upon by a specialist or GP if unsure.)


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People who are pregnant with significant heart disease, congenital or acquired o If you are being followed up by a specialist heart clinic during your

pregnancy then you fall within this group People who are receiving renal dialysis treatment

o People receiving and those starting renal dialysis.

From 10 July, people who are shielding at home can:

stop physically distancing from the people they live with

use indoor toilets in other people’s houses when visiting them outdoors

meet up to eight people outdoors, from two other households, in a single day

travel as far as they want from their house

book self-catering accommodation or travel to a second home - staying over

with people they live with at home.

People who live alone can agree with another household to form an ‘extended

household’ and visit that household indoors and stay over without physical distancing.

This applies to adults who are shielding and live only with children under 18.

Scotland currently advises that children aged 11 and under can play outdoors, without

physical distancing, in groups of up to eight, from no more than two other households.

This now includes children aged 11 and under who live with someone who is shielding.

Further relaxing of the shielding advice is expected on 17 July.(16) This may include

allowing those shielding to use all types of holiday accommodation, go to outdoor

markets and visit outdoor public gardens. From 24 July, this may include the use of

childcare facilities, meeting indoors with up to eight people from two households with

physical distancing, use of public transport while wearing a face covering, going in a

car with someone they do not live with, going to pubs and restaurants with outdoor

spaces, going inside other buildings wearing a face covering, including shops and

pharmacies, indoor markets, hairdressers and barbers, museums and galleries,

libraries and cinemas.

Currently, children who have been asked to shield should not attend school and

children who live with someone who has been asked to shield should only attend

school if they can strictly follow physical distancing while there. On 2 June, the

advice to children and young people who are shielding is to contact their GP or

clinician to discuss whether they need to continue to shield. This is informed by

updated guidance published by the Royal College of Paediatrics and Child Health

which suggests that many children and young people do not need to shield.(17)

Specific advice is provided for those with specific medical conditions, including:

cancer; diabetes; heart disease; IBD; chronic kidney and liver disease;

dermatological; neurological; (specific) ophthalmic respiratory and rheumatic

conditions; chronic pain, and rare diseases.(18)

https://www.rcpch.ac.uk/resources/covid-19-shielding-guidance-children-young-people

https://www.gov.scot/publications/coronavirus-covid-19-tailored-advice-for-those-who-live-with-specific-medical-conditions/


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On 11 May, the HPS updated their methods for identifying patients that meet the

shield criteria.(19) The document sets out details of the groups, as defined by the

criteria listed above. It serves the same function as the NHS Digital Shielded Patient

List (see England, Public Health England (PHE)).

From 23 May, those at increased clinical risk are able to leave their home for

essential purposes. This includes people over 70 years of age, pregnant women and

those who receive the influenza vaccination for medical reasons.(20) From 19 June,

people in this group can meet with up to two households outside (subject to an

eight person overall limit) and can also use toilets indoors while visiting the outdoors

of another household.(21)

Wales, Welsh Government

Since 24 March, the Welsh government has been following PHE advice on shielding

and protecting people defined on medical grounds as extremely vulnerable from

COVID-19. The criteria for identifying people in this group are identical to the PHE

criteria with the addition of children up to the age of 18 with significant heart

disease, congenital or acquired (see Table 1 for full criteria).

An update was made on 1 June to allow those shielding to leave home, to exercise

or meet outside with people from another household. This is reportedly due to fewer

people infected with COVID-19 and as a result, the risk of catching COVID-19 has

reduced. In addition, it is acknowledged that the risk of catching COVID-19 when

outside is low, providing physical distancing and good hygiene measures are strictly

followed. On 4 June this advice was updated to allow those shielding to leave home

to exercise or meet outside with people from another household locally and continue

to avoid gatherings indoors including going shopping. This will remain in place until

16 August 2020.(22) On the 12 June, children who are at high risk were advised not

to attend school but should continue to learn from home. As of 29 June, this advice

remains unchanged. On 6 July, those shielding can now form an extended bubble

exclusively with another household, while maintaining physical distancing where

possible. Currently, those shielding are not advised to go back to their normal place

of work.(23)

Australia, Department of Health

On 24 March, further measures to limit the spread of COVID-19 were introduced in Australia. This moved the country away from a policy of physical distancing to one of a more restrictive nature, such as protective self-separation. The updated advice was for everyone to stay at home, including those at highest risk of severe illness. On the 23 April specific examples of haematologic neoplasm and additional details for disease-modifying anti-rheumatic drugs were included in the criteria for those at high risk. People at higher risk include:

people aged 70 years and over people aged 65 years and over with chronic medical conditions people with compromised immune systems (for example, cancer)

https://hpspubsrepo.blob.core.windows.net/hps-website/nss/3008/documents/1_covid-19-search-criteria-highest-risk-patients.pdf


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aboriginal and Torres Strait Islander people aged 50 years and over with one or more medical conditions.

Having two or more conditions increases risk, regardless of age. If the condition is

severe or poorly controlled, this might also increase the risk of serious illness from

COVID-19.

Chronic conditions that indicate high risk include:

have had an organ transplant and on immune suppressive therapy have had a bone marrow transplant in the past two years on immune suppressive therapy for graft versus host disease have had blood cancer, in the past five years, including leukaemia, lymphoma

or myelodysplastic syndrome are having chemotherapy or radiotherapy.

Chronic conditions that indicate moderate risk include:

chronic kidney (renal) failure heart disease (coronary heart disease or failure) chronic lung disease, excluding mild or moderate asthma a non-haematological cancer (diagnosed in the last 12 months) diabetes severe obesity with a body mass index of 40 kg/m2 or more chronic liver disease some neurological conditions such as stroke or dementia some chronic inflammatory conditions and treatments other primary or acquired immunodeficiency poorly controlled hypertension (may increase risk)

Other factors might also increase the risk of moderate or severe illness if COVID-19 is contracted, including:

age - risk increases with age, even for those under 70 being male poverty smoking

Since 10 May, Australia has initiated a 3-step framework for easing restrictive measures.(24) Those at the highest risk of severe illness were advised to stay at home and work from home if possible, avoid non-essential travel, avoid contact with others and avoid public gatherings. Since 6 July, further relaxing of the advice is to include considerations such asavoiding large public gatherings while maintaining physical distance and staying away from other people who are sick or in isolation.(25)

Canada, Government in Canada

In Canada, the Public Health Agency has advised those considered at high risk of severe illness from COVID-19 to practice ‘protective self-separation’, which involves

https://www.health.gov.au/resources/publications/3-step-framework-for-a-covidsafe-australia

https://www.canada.ca/en/public-health/services/publications/diseases-conditions/people-high-risk-for-severe-illness-covid-19.html

https://www.canada.ca/en/public-health/services/publications/diseases-conditions/people-high-risk-for-severe-illness-covid-19.html


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avoiding unnecessary face-to-face social interaction and physical contact with others.(26) These groups, as defined by the WHO, include:

older adults (age not specified) those with underlying medical conditions (such as heart disease,

hypertension, diabetes, chronic respiratory diseases, cancer) those who are immunocompromised as a result of a medical condition or

treatment (for example, chemotherapy).

In addition to the advice to stay at home as much as possible, people who fall into these categories are advised to avoid contact with others, especially those who have travelled or been exposed to the virus, keep at least 2 metres physical distance, avoid crowds and large gatherings, avoid cruises and non-essential travel outside of Canada.

Additional social groups that may be vulnerable to severe illness were defined as anyone who has:

Difficulty reading, speaking, understanding or communicating Difficulty accessing medical care or health advice Difficulty doing preventive activities, like frequent hand washing and

covering coughs and sneezes Ongoing specialised medical care or groups that need specific medical

supplies Ongoing supervision needs or support for maintaining independence Difficulty accessing transportation Economic barriers Unstable employment or inflexible working conditions Social or geographic isolation, like in remote and isolated communities Insecure, inadequate, or non-existent housing conditions.

Finland, Finish Institute of Health and Wellness (THL)

On 2 April, it was estimated that 200,000 people aged 18 to 69 are at high risk due

to illness and 870,000 people are at higher risk due to advanced age, compared to

the rest of the population. People over 70 years of age are more susceptible to

severe coronavirus infections.

In addition, the risk of developing a severe coronavirus infection may be increased

by pre-existing conditions that significantly impair the functioning of the lungs,

heart, or immune system. These include:

Severe heart disease Lung disease that is not clinically stabilised Diabetes that involves organ damage Chronic liver or kidney failure Diseases that weaken the immune system, such as leukaemia or lymphoma

that is currently undergoing cytostatic treatment (not maintenance therapy) Medication which significantly weakens the immune system (e.g. high-dosage

cortisone therapy).


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Other factors that generally impair lung functioning and may increase the health risk

of a coronavirus infection include morbid obesity (BMI over 40) and daily smoking.

Since 16 March 2020, the Finish Government imposed an obligation on those over

70 years of age to avoid close contact with other people as far as possible. This

means that they can go out provided they practice physical distancing. Shopping is

permitted if crowds can be avoided. As of 23 June, the Government of Finland no

longer issues an age-based recommendation to avoid physical contact. However, in

close contacts, it is advisable to take a cautious approach using individual discretion

and taking the overall situation and the individual risk factors into account.(27)

When visiting a person in this risk group, it is currently advised to avoid handshakes,

hugging and other close contact unless essential for care or treatment reasons, in

the case of staff, for instance. Cover mouth and nose with a disposable tissue if no

mask is available. Informal carers and personal assistants are advised to avoid close

contact with other people where possible and if necessary to keep it as short as

possible and protect their self as well as possible.

On 16 June, the THL published a press release relating to risk groups and the health

hazards of hot weather. People within this group are advised to avoid using a fan in

common areas with more than one person present or confined spaces with poor

ventilation.(28)

Germany, Robert Koch Institute (RKI)

On 21 May, an assessment by the RKI found the risk level to the health of the

German population overall was high and very high for the following risk groups:

older people (with a steadily increasing risk of severe course from around 50 to 60 years; 86% of those who died from COVID-19 in Germany were 70 years old or older [median age: 82 years])

smokers very obese people people with certain medical conditions:

o of the cardiovascular system (for example, coronary heart disease and high blood pressure)

o chronic diseases of the lungs (for example, COPD) o patients with chronic liver disease o patients with diabetes mellitus o patients with cancer o patients with a weakened immune system (for example, due to a disease

that is associated with an immunodeficiency or by taking medication that can influence and reduce the immune defence, such as cortisone, on a regular basis).

The current advice for these groups is to reduce interaction with others as much as

possible and avoid close physical contact. This includes meeting the same people,

limiting the length of visits and trying to meet outside where possible. If meetings

occur indoors, people are advised to ensure rooms have good air circulation. It is

https://valtioneuvosto.fi/en/article/-/asset_publisher/1271139/mita-yli-70-vuotiaan-pitaa-ottaa-huomioon-koronavirustilanteessa-

https://thl.fi/en/web/thlfi-en/-/risk-groups-should-protect-themselves-from-the-health-hazards-of-hot-weather-remember-the-prevention-of-coronavirus-infections-as-well?redirect=%2Fen%2Fweb%2Finfectious-diseases-and-vaccinations%2Fwhat-s-new%2Fcoronavirus-covid-19-latest-updates

https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Risikogruppen.html

https://www.zusammengegencorona.de/en/inform/prevention/


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also recommended to wear a mask in public spaces. Families can visit their

grandparents and other family members.

On 7 May, a summary of current evidence on pregnancy and associated risk was

published by the RKI. This is presented below with references to relevant studies

where cited:

For pregnant women:

Acquisition of infection - There is currently no data on susceptibility to SARS-

CoV-2 infection in pregnant women. Due to the physiological adaptation and

immunological changes during pregnancy, an increased susceptibility to

infections by SARS-CoV-2 cannot be excluded.

Clinical presentation- Pregnant patients seem to develop symptoms less

frequently, corresponding to a low manifestation index. In a screening study

of 215 women in the third trimester, 33 women (15%) tested positive, but

only 4 (12%) of the 33 women tested positive had symptoms.(29) Another

study showed that pregnant women had fewer fevers than the control group.

The indication for examination for SARS-COV-2 can therefore be made

generously in pregnant patients.

Severity of the course of the disease in pregnant women - There are only a

few studies to date, in which pregnant women with COVID-19 were

examined.(29-32) These available studies and the results of the report of the

“WHO-China Joint Mission on Coronavirus Disease 2019”(33) provide no

indication of a more severe course of COVID-19 in pregnant women compared

to non-pregnant women. Deaths seem to occur very rarely, individual cases

have so far been reported.(34) It is possible that an increased risk of a severe

course can only be reliably examined in population-based studies.

Since COVID-19 can be associated with hypercoagulability and there is also

physiological hypercoagulability during pregnancy, the indication for

thromboprophylaxis should be carefully examined.(35)

For unborn children:

There is little data on this question, especially no long-term data, so no valid

statements can be made about this question. Basically, high fever during the

first trimester of pregnancy can increase the risk of complications and

malformations.

New Zealand, Ministry of Health

On 25 March, New Zealand moved to Level 4 of its four-level alert system. The advice

to everyone in New Zealand was to stay at home, except for those providing essential

services. In particular people over 70 or people with existing underlying medical

conditions were advised to follow the advice.(36) Since 7 July, the New Zealand

https://covid19.govt.nz/health-and-wellbeing/people-at-risk-of-covid-19/


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Government directs readers to the Ministry of Health guidance. The criteria previously

listed largely overlaps with the New Zealand Government criteria.

On 15 May, the Ministry published an updated list of medical conditions and

treatments that are risk factors for severe illness from COVID-19 and other factors

contributing to a higher risk (see below).(38) This was last updated on 11 June.

Relevant medical conditions include:

chronic lung disease such as cystic fibrosis, bronchiectasis, chronic obstructive respiratory disease and emphysema, severe asthma that needs multiple medications and medical care

serious heart conditions such as congestive heart failure hypertension that is not well controlled diabetes that is not well controlled chronic kidney disease liver disease.

Conditions and treatments that weaken the immune system include:

having chemotherapy or radiotherapy bone marrow or organ transplantation some blood cancers immune deficiencies including HIV infection immunity weakening medications such as high-dose corticosteroids and

disease-modifying anti-rheumatic drugs that treat inflammatory forms of arthritis.

older people (updated 15 May) people in aged care facilities (updated 15 May).

Other factors contributing to risk (updated 15 May):

ethnicity smoking obesity (BMI of 40 or higher) pregnancy (pregnant women in their third trimester).

New guidance was issued when New Zealand transitioned from Alert Level 4 to Alert

Level 3 on 28 April. For those in the at-risk groups, the advice focused on creating a

safe ”bubble”, as detailed in Table 1. On 2 May, the Ministry published advice for

these groups on how to manage their “bubble”, which stated that they can leave

their house for activities when previously they were advised not to. If people share

their bubble with someone who is more vulnerable to COVID-19, then the risks of

extending their bubble needs to be considered.

On 29 April, the dedicated government website covid19.gov.nz advised pregnant

women to take extra precautions during the third trimester as a growing baby puts

increased oxygen demands on the woman. Pregnant women working in areas where

there is high risk of exposure to COVID-19, for example, some healthcare settings,

were advised to discuss and agree with their employer an assessment of the risk and

options for working differently if needed.

https://covid19.govt.nz/health-and-wellbeing/people-at-risk-of-covid-19/

https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-information-specific-audiences/covid-19-advice-higher-risk-people


https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-novel-coronavirus-health-advice-general-public/managing-your-bubble-during-covid-19

http://www.covid19.gov.nz/


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On 13 May, New Zealand moved to Alert Level 2 and allowed those at risk to meet

friends and family outside of the home. On 8 June, New Zealand has moved to Alert

Level 1. At Level 1, everyone can return without restriction to work, school, sports

and domestic travel, and can get together with as many people as they want.(37) For

people at higher risk of COVID-19, the following advice has been issued for Alert

Level 1:

keep a 2 metre distance from people you don’t know in public places and take extra care with hygiene practices

avoid touching surfaces and wash your hands before and after you leave home

wipe keys, handrails and regularly touched surfaces avoid passing around your mobile phone to other people.

Norway, Norwegian Institute of Public Health (NIPH)

On 17 April, the NIPH amended its criteria for high-risk groups,(39) moving the

majority of conditions into a category for ”those that may be at risk of severe

COVID-19 disease”. These groups included those aged over 65 years, cardiovascular

disease (including high blood pressure), and diabetes. On 21 May, the criteria for

two new risk groups replaced the previous criteria. The risk groups describe those

that are considered to be at ‘moderate to high risk’ and ‘slightly increased risk’ of

severe illness from COVID-19. For each risk group, specific advice is provided, which

depends on the rate of transmission in the community of the applicable person (low-

level spread and widespread community transmission). Currently, NIPH reports that

the transmission of the virus is low in all counties in Norway, but there may be local

clusters of transmission, for example in workplaces, regions, or municipalities.(40)

People at moderate (clinically vulnerable) and or high risk (clinically extremely

vulnerable) include:

Those over 80 years of age Residents of nursing homes Those aged 66 to 80 years with one of the following chronic diseases, OR

aged 50 to 65 years with two or more of the following chronic diseases: o cardiovascular disease (other than well-regulated high blood pressure) o morbid obesity (BMI ≥ 30 kg/m2 in combination with weight-related

diseases or BMI ≥ 40 kg/m2) o diabetes o chronic kidney disease and kidney failure o chronic lung disease (other than well-regulated asthma) o chronic liver disease o in immunosuppressive therapy such as chemotherapy, radiation therapy

and immunosuppressive therapy in autoimmune diseases. Those with severe health condition, regardless of age*:

o people with active cancer, ongoing or recently discontinued treatment for cancer (especially immunosuppressive therapy, radiation therapy to the

https://www.fhi.no/en/op/novel-coronavirus-facts-advice/facts-and-general-advice/risk-groups---advice-and-information/



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lungs or chemotherapy). Leukaemia has a higher risk than other types of cancer

o neurological or muscular disease with impaired coughing strength or lung function (e.g. ALS)

o congenital immunodeficiency in an unstable phase that carries the risk of severe respiratory tract infections

o blood disorders that include cells or organs that are important for the immune system

o bone marrow transplant or organ transplant o HIV infection with low CD4 counts o significant renal impairment or significantly impaired liver function o other, assessed by a physician.

*Some serious health conditions in this list are included due to a precautionary principle, although at present there are no studies indicating a higher risk of severe progression for the diseases.

The advice for people in this group (that is, ‘moderate to high risk’) depends on whether transmission is low or widespread in their communities:

Low-level spread (current situation):

Increase physical distancing You can be with your closest circle as normal, and travel and socialise with

others as long as: o you and your closest circle are particularly careful to follow general

advice, keeping a safe distance and good hand hygiene and cough etiquette

o you limit your number of close contacts o you avoid crowded places (e.g. public transport, shopping malls) or only

go to such places when they are quieter. Workplace planning and adjustment may be appropriate.

Widespread transmission or community outbreaks:

Social shielding To avoid infection, you should withdraw during this period. You can go

outside and maintain normal contact with your closest circle as long you: o keep a greater distance from others (preferably 2 metres) than your

closest circle o ask others to help you with necessary purchases o your closest circle should also limit their social contact. If not, you should

keep a safe distance to them. If this is not possible, it might be necessary to consider other temporary housing arrangements.

If workplace adjustments or remote working is impossible, sick leave should be considered.

People at slightly increased risk include those:

Aged 65–80 years (especially over 70) Aged 50–65 years with one of the following chronic diseases:

o cardiovascular disease (other than well-regulated high blood pressure)


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o morbid obesity (BMI ≥ 30 kg/m2) in combination with weight-related diseases or BMI ≥ 40 kg/m2)

o diabetes o chronic kidney disease and kidney failure o chronic lung disease (other than well-regulated asthma) o chronic liver disease o in immunosuppressive therapy such as chemotherapy, radiation therapy

and immunosuppressive therapy in autoimmune diseases. People under 50 years of age have a lower risk of developing severe COVID-

19 disease. However, some people with poorly-regulated chronic conditions or a combination of several chronic diseases might be at increased risk.

The advice for people in this group also depends on whether transmission is low or widespread in their communities:


Live like others

You can generally live like the rest of the population, travel, work and attend events, but be particularly careful to follow the general advice: o keep the recommended distance to people, apart from your closest circle o remember hand hygiene and cough etiquette o stay home when you are ill o avoid being with people who are sick.

Consider whether you will be able to follow these measures before travelling or participating in social activities.

Widespread transmission or community outbreaks:

Increase social distancing You can be in normal contact with your closest circle, and travel and socialise

with others as long as: o you and your closest circle are particularly careful to follow general

advice, keeping a safe distance and follow good hand hygiene and cough etiquette.

o you limit your number of close contacts o you avoid crowded places (for example, public transport, shopping malls)

or only go to such places when they are less busy Workplace planning and adjustment may be appropriate.

These protective measures could be described as ‘protective self-separation’, although the Norwegian Institute of Public Health does not use any label to describe the advice issued.

On 17 April, advice is offered on a method of assessment for risk groups at work, which is based on age and underlying chronic conditions. Employees in risk groups are advised to talk to their employer about the possibility of remote working and videoconference facilities. Sick leave is not recommended unless workplace adjustment or remote working is not possible. The advice for the specific groups is as follows:


Page 25 of 61

Aged over 65 years - It is particularly important to shield this group from infection. The need for shielding applies especially to people with underlying chronic conditions.

Aged 50-65 years - This group has a lower risk of severe disease than people over the age of 65. People with chronic conditions may be at increased risk of severe disease, but the risk is expected to be limited if their condition is well regulated. The need for shielding for COVID-19 infection should therefore be considered on an individual basis.

Aged under 50 years - The risk of severe COVID-19 disease is low in this group. Further shielding is usually not necessary but may be appropriate for people with chronic conditions that are poorly regulated or with multiple chronic conditions.

Advice is also provided to someone who has developed symptoms and lives with a person who is at higher risk. This includes:

If you live with someone who is at risk, and you have symptoms of a respiratory tract infection or do not feel well, then you should limit time spent together.

If possible, stay and sleep in separate rooms and have your own bathroom or toilet.

If this is not possible, try to keep your distance and have a separate towel in the bathroom or toilet and your own toiletries.

Singapore, Ministry of Health

On 24 March, the Multi-Ministry Taskforce in Singapore introduced tighter measures

to minimise the further spread of COVID-19. Included in the measures was specific

advice for older adults [age not specified] and anyone with underlying medical

conditions. On 5 June, an advisory issued by the Ministry of Health provided further

indications for risk of poorer clinical outcomes in the event of infection.(41) These

include:

Persons who are aged 60 and above Patients who are immunocompromised or have concurrent medical conditions

such as obesity (BMI > 31), hypertension, diabetes, chronic heart and lung diseases, kidney diseases on dialysis, hypercoagulable states, cancer, or patients on drugs that cause immunosuppression.

The advice to these groups was to avoid social gatherings and crowded places as far

as possible, and only go out for essential purposes, such as to work or buy food.(42)

The advice is similar to the advice issued in Ireland, and could be described as

‘protective self-separation’. On 21 April, it was announced that the emergency

measures would be extended for another four weeks, until 1 June, with no specific

reference to vulnerable groups. A press release published by the Ministry on 19 May,

suggested that the advice for vulnerable groups was likely to remain the same after

1 June.(43) Since 2 June, families may visit their parents or grandparents, capped at

two persons per household per day.(44) On 19 June, Singapore moved to Phase Two

where the majority of activities were said to have resumed.(45) The advice in Phase

Two for those at high risk is to continue to exercise extra caution and stay at home

https://www.moh.gov.sg/news-highlights/details/end-of-circuit-breaker-phased-approach-to-resuming-activities-safely


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as much as possible. Grandparents can now provide childcare on a daily basis but

parents are advised to take the necessary safe distancing precautions to protect

these grandparents. Observe personal hygiene, reduce interaction time as far as

possible when visiting their home and do not visit if unwell.(46)

Sweden, Public Health Agency of Sweden

On 1 April, the Public Health Agency advised all those with symptoms of COVID-19

to avoid social contact, in order to reduce the risk of spreading the virus. The

Agency also advised those aged 70 years or over to limit their contacts with other

people and not to travel by public transport, (for example, by train, bus, tram or

subway), or visit supermarkets or other venues where a large group of people may

be gathered at the same time. From 1 April, all private visits to nursing homes were

prohibited by the government. On 15 June, this was extended until 31 August.(47)

There is an increased risk of severe illness from COVID-19 among those of old age,

along with those with pre-existing medical conditions such as:

High blood pressure Cardiovascular disease Pulmonary disease Diabetes.

The Public Health Agency of Sweden also advised that people with asthma, allergies,

or kidney disease may be at high risk of severe illness from COVID-19, but the

evidence is unclear. In addition, it advised that people with conditions that make

them vulnerable to infectious diseases, for example, due to problems with the

immune system, should seek advice from their doctor about how to manage their

condition and how to decrease the risks associated with COVID-19.

Additional information relating to those at high risk was published on 5 June.(48) This

is said to be informed by a recent preprint publication of a study conducted using a

dataset of 17 million adult NHS patients collected since the beginning of February.(49)

Below is a translation of the additional information.

The risk of becoming seriously ill gradually increases with age:

those who are 60-70 years of age have twice the risk of becoming seriously ill, compared to someone who is 50-60 years of age

those who are 70-80 years of age have a five-fold higher risk of becoming seriously ill, compared to those who are 50-60 years

the risk is greatest for those over 80 years of age. Then the risk of getting seriously ill is twelve times higher than for a person who is 50-60 years.

70 years and older

Below, are some diseases that in addition to rising age, Public Health Agency of

Sweden consider to further increase the risk of becoming seriously ill.

organ transplantation blood cancer diseases, existing and past

https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/rad-och-information-till-riskgrupper/

https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1


Page 27 of 61

neurological disorders (for example, MS, Parkinson's, Myastenia gravis) obesity (increased risk with increased levels of obesity) diabetes (less risk if well treated) current cancer treatment chronic pulmonary disease (including asthma, but very marginal if well

treated) stroke / dementia other immunosuppressive disease or treatment liver disease impaired kidney function cardiovascular disease.

High blood pressure alone does not appear to increase the risk, and is therefore

no longer on the list.

Younger than 70 years

People under the age of 70 may also be at increased risk of becoming seriously ill

if they have:

any or all of the diseases mentioned above any disease that involves an increased risk of serious disease in respiratory

tract infections.

These groups are not counted as risk groups:

children even those who have any of the conditions or illnesses that increase the risk for adults and the elderly

people who smoke are not a risk group but tobacco smoking increases the risk of serious symptoms of respiratory infections.

The Agency states that according to current knowledge, pregnant women do not

appear to be at higher risk than others of being affected by severe illness from

COVID-19, but acknowledged that there have been some instances where pregnant

women have needed intensive care in Sweden. The Agency advised that pregnant

women should be extra careful, especially at the end of their pregnancy and before

giving birth. This is because a respiratory infection during late stages of pregnancy

can pose a risk for the woman. Pregnant women with risk factors such as high blood

pressure, diabetes, and obesity should be extra careful, consult with the midwife or

physician, and limit close contact with people outside the household.

Currently, people considered at high risk have been are advised to:

Try to stay at home, but there is no obstacle to, for example, taking a walk and being outdoors in settings with only a few people at a safe distance

Avoid crowds in shops and public premises, on public transport, etc. Keep their distance from others both indoors and outdoors.

On 20 April, a report (link – in Swedish) from the Swedish National Board of Health

and Welfare (‘Socialstyrelsen’) identified the groups most at risk of being severely

affected if they contract COVID-19. The criteria are listed in Table 1.

https://www.krisinformation.se/en/hazards-and-risks/disasters-and-incidents/2020/official-information-on-the-new-coronavirus/riskgrupper

https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/dokument-webb/ovrigt/identifiering-av-riskgrupper-covid19.pdf


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On 11 May, the Ministry of Health and Social Affairs published an article for older

people, people with health conditions, and health care and social services staff. The

article outlined measures, advice, and restrictions specific to these populations.(50)

In addition to avoiding close contact with others, as from 13 June, the PHA advises

people 70 years of age and older that travel is now possible but that they should

avoid public transport if they cannot book a seat in advance, and to avoid busy

venues.(51)

Switzerland, Federal Office of Public Health (FOPH)

In Switzerland, the following groups have been identified as at high risk:

Those over the age of 65 Those who have one of the following conditions:

o High blood pressure. o Cardiovascular disease o Diabetes o Chronic respiratory diseases o Cancer o Conditions and therapies that weaken the immune system o Obesity class III (morbid, BMI greater than or equal to 40 kg/m2).

People who are at high risk are being advised to stay at home. If they do leave the home, they should strictly follow hygiene and physical distancing guidelines and avoid places frequented by large numbers of people. For example, railway stations, public transport or shopping centres during peak times,(52) and avoid unnecessary contacts. Although the guidance issued in Switzerland has not been labelled, it is consistent with ‘protective self-separation’.

Additional conditions, listed in Table 1, are detailed in the Ordinance on Measures to Combat the Coronavirus (COVID-19), which is updated by FOPH when evidence emerges (short version). According to this document, persons at high risk may not be involved in providing services at schools, higher education institutions and other education and training institutions. The first phase of measures to protect the public have been eased, but the advice still applies. Additional guidance issued to these vulnerable groups is listed in Table 1.

The FOPH advises that adults should only visit their parents if they need assistance that they cannot get elsewhere. Since 20 May, visiting old people’s and nursing homes are is allowed in principle, but the rules are set at canton level (member states of the Swiss Confederation).(53) As of 22 June, people at especially high risk can resume work.(54) Children who share a home with someone at especially high risk should be allowed to go to school.

On 11 May schools resumed in Switzerland and advice was issued to grandparents over the age of 65 or with an underlying medical condition, instructing them not to look after their grandchildren.(53) This advice has been updated to allow grandparents to look after grandchildren, except when either person is ill. They are advised, however, to keep their distance from the parents.

https://www.government.se/articles/2020/05/about-covid-19--for-older-people-people-with-health-conditions-and-health-care-and-social-services-staff/

https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/covid-19/?exp=69332#_69332

https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/besonders-gefaehrdete-menschen.html

https://www.admin.ch/opc/en/classified-compilation/20200744/index.html

https://www.admin.ch/opc/en/classified-compilation/20200744/index.html

https://www.bag.admin.ch/dam/bag/en/dokumente/mt/k-und-i/aktuelle-ausbrueche-pandemien/2019-nCoV/kategorien-besonders-gefaehrdete-personen.pdf.download.pdf/Liste-besonders-gef%C3%A4hrdeter-Personen_Anhang-6_ab%2024.06.2020_EN.pdf

https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/haeufig-gestellte-fragen.html#188370762


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US, Centers for Disease Control and Prevention (CDC)

In the US, those aged 65 years and older are considered at high risk for severe

illness from COVID-19. These people are being asked to stay at home if possible and

maintain physical distancing when outside the home (6 feet).(55) The groups listed

below have also been identified as high risk,(56) but no guidance has been issued for

these groups. An update on 2 April included additional conditions associated with

being immunocompromised. As of 7 April, people who are pregnant are no longer

listed as high risk, this was said to be based on available information: ‘we do not

currently know if pregnant people have a greater chance of getting sick from COVID-

19 than the general public nor whether they are more likely to have serious illness

as a result’. On 5 May, additional information was provided for people with chronic

liver disease, including hepatitis B and hepatitis C.

On 25 June, the CDC updated their guidance to provide more details on how age

and underlying conditions contribute to the risk of severe illness from COVID-19.

This is reported to be based on a review of the evidence available up to the 29

May.(57) People aged 65 or older were previously included as high risk, whereas now

it is advised that risk increases with age but no specific cut off age point is provided.

Underlying conditions are now listed in two risk groups - increased risk or might be

at increased risk (see below). Severe asthma and some of the conditions previously

listed that can cause immunocompromised states are no longer considered to belong

to the increased risk category.

People of any age with the following conditions are at increased risk of severe illness from COVID-19:

Chronic kidney disease COPD (chronic obstructive pulmonary disease) Immunocompromised state (weakened immune system) from solid organ

transplant Obesity (BMI of 30 or higher) Serious heart conditions, such as heart failure, coronary artery disease, or

cardiomyopathies Sickle cell disease Type 2 diabetes mellitus Children who are medically complex, who have neurologic, genetic, metabolic

conditions, or who have congenital heart disease.

People with the following conditions might be at an increased risk for severe illness

from COVID-19:

Asthma (moderate-to-severe) Cerebrovascular disease (affects blood vessels and blood supply to the brain) Cystic fibrosis Hypertension or high blood pressure Immunocompromised state (weakened immune system) from blood or bone

marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/evidence-table.html


Page 30 of 61

Neurologic conditions, such as dementia Liver disease Pregnancy Pulmonary fibrosis (having damaged or scarred lung tissues) Smoking Thalassemia (a type of blood disorder) Type 1 diabetes mellitus.

Advice for those at increased risk is to limit interactions with other people as much as

possible and to take precautions to prevent getting COVID-19 when interacting with

others. This includes wearing a mask when it is difficult to stay at least six feet apart

from others outside their household, and avoiding others who are not wearing a mask

or asking those in close proximity to wear a mask.

A breakdown in terms of risk level for different types of events is provided to assist

those at increased risk when considering attending an event or gathering.(57) This is

as follows:

Lowest risk: Virtual-only activities, events, and gatherings. More risk: Smaller outdoor and in-person gatherings in which individuals from

different households remain spaced at least 6 feet apart, wear cloth face coverings, do not share objects, and come from the same local area (e.g., community, town, city, or county).

Higher risk: Medium-sized in-person gatherings that are adapted to allow individuals to remain spaced at least 6 feet apart and with attendees coming from outside the local area.

Highest risk: Large in-person gatherings where it is difficult for individuals to remain spaced at least 6 feet apart and attendees travel from outside the local area.

Conclusion

A variety of protective measures are being taken to protect vulnerable groups who

are at a high risk of severe illness from COVID-19. These broadly involve social or

physical distancing and protective self-separation. However, highly protective

measures are also being taken to shield, or cocoon, those who are considered

extremely medically vulnerable to severe illness from COVID-19, as evidenced in

Ireland and the UK.(1, 5)

All 14 countries included in the review have published inclusion criteria for

‘vulnerable groups’. Australia, Canada, Finland, Germany, New Zealand, Singapore,

Sweden, Switzerland, US and Wales have a single grouping, while England, Northern

Ireland, Scotland and Norway distinguish between those considered at ‘highest risk’

and those at ‘increased risk’.

In general, people who are considered vulnerable to more severe illness are those

that are older aged, those with chronic conditions such as diabetes, high blood

pressure and respiratory conditions and those in receipt of therapies that weaken

the immune system. Some countries have published additional risk factors that

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.html


Page 31 of 61

increase risk, although these do not always require inclusion in the vulnerable group

category. These risk factors include ethnicity, smoking, high BMI and pregnancy in

conjunction with another condition.

Specific advice is provided by all countries for people who are vulnerable. This

typically includes advice to stay at home, practice hand hygiene, physical distancing

and avoid all contact with others. For the countries that distinguished high risk from

highest risk, proportionate advice is given. This usually means those at highest risk

are advised to not leave the house, while those that are a high risk could leave the

house but were strongly advised to practice physical distancing and not to meet

others. For Norway, the advice is further stratified according to local transmission

levels, with higher restrictions in place where community case numbers are high.

As some countries have begun easing restrictions, the advice for people at higher

risk has changed to include the choice to go outside and for some countries this has

also included meeting people outside of their household, including physical contact

with grandchildren.

As of 19 June, all four neighbouring countries of Ireland allow those who are

shielding or cocooning to go outside and in specific situations to meet with people

from other households.

Since 6 July, further relaxing of the shielding advice in Scotland includes advice that

physical distancing is no longer required for people in the same household, and to

allow the use of indoor toilets when visiting outside, increase in the numbers of

contacts outside and the removal of the five mile travel restriction. Self-catering

accommodation and travel to a second home are possible, as long as it is to stay

with only those from within the same household. Children aged 11 and under who

live with someone who is shielding can now play with other children without physical

distancing. Further relaxing of the shielding advice is expected on 17 and 24 July.

Australia has redesigned the criteria for high risk to now also include a moderate risk

category. People with chronic conditions are advised to avoid crowds and people

who are ill, while older people are advised to continue to stay at home and avoid

contact with others and avoid non-essential travel. New Zealand now directs website

visitors from the main government COVID-19 website to the Ministry of Health, with

no change in criteria or advice.

Although some of the measures may seem stringent, research by Ferguson et al.(58)

in March 2020 suggested that physical distancing of the elderly and others most at

risk of severe disease, in combination with home isolation of suspected cases and

home quarantine of those living in the same household as suspected cases, could

considerably reduce hospital demand and mortality.

Protective measures for vulnerable groups may also be in place in other settings that

were not identified in this rapid review.


Page 32 of 61

The findings from this rapid review were accurate as of 10 July 15.00 GMT;

however, it is important to note that the protective measures identified above may

change as the situation and response to COVID-19 evolves.


Page 33 of 61

Table 1 Overview of protective measures for vulnerable groups from COVID-19 [UPDATED 10/07/2020 15.00 GMT]

Country /

setting

Protective

measure

Vulnerable/high-risk groups Specific advice

Australia

Guidance provided by:

Department of Health

Protective

self-

separation

People at higher risk include:

people aged ≥ 70 years

people aged ≥ 65 years with chronic medical conditions people with compromised immune systems (e.g. cancer)

aboriginal and Torres Strait Islander people aged ≥ 50 years with one or more medical conditions.

Having 2 or more conditions increases risk, regardless of age. If the condition is severe or poorly controlled, it might also increase

the risk of serious illness from COVID-19.

Considered high risk if: had an organ transplant and are on immune suppressive

therapy had a bone marrow transplant in the past 2 years

on immune suppressive therapy for graft versus host disease

had blood cancer, in the past 5 years, including leukaemia, lymphoma or myelodysplastic syndrome

having chemotherapy or radiotherapy.

Considered moderate risk if had:

chronic kidney (renal) failure heart disease (coronary heart disease or failure)

chronic lung disease, excluding mild or moderate asthma

a non-haematological cancer (diagnosed in the last 12 months)

diabetes severe obesity with a body mass index of 40 kg/m2 or more

chronic liver disease

some neurological conditions such as stroke or dementia some chronic inflammatory conditions and treatments

other primary or acquired immunodeficiency poorly controlled hypertension (may increase risk)

Other factors might also increase the risk of moderate or severe

illness if COVID-19 is contracted include:

People with chronic conditions are advised to:

maintain good hygiene

practise physical distancing avoid large public gatherings

stay home and get tested if sick stay away from other people who are sick or in

isolation Older people are advised to continue to stay at

home:

stay 1.5 metres away — 2 arms length from other people.

continue to stay at home and avoid contact with others

continue to avoid non-essential travel

https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/advice-for-people-at-risk-of-coronavirus-covid-19/coronavirus-covid-19-advice-for-people-with-chronic-health-conditions

https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/advice-for-people-at-risk-of-coronavirus-covid-19/coronavirus-covid-19-advice-for-people-with-chronic-health-conditions


Page 34 of 61

Country /

setting

Protective

measure


age - risk increases with age, even for those under 70

being male

poverty

smoking

Canada

Guidance

provided by: Government

of Canada

Protective self-

separation

Older adults [age not specified]

Those with chronic underlying medical conditions (such as

high blood pressure, heart disease, lung disease, cancer or diabetes)

Those who are immunocompromised as a result of a medical

condition or treatment (e.g. chemotherapy).

Social groups that may be vulnerable including anyone who has: Difficulty reading, speaking, understanding or communicating

Difficulty accessing medical care or health advice

Difficulty doing preventive activities, like frequent hand

washing and covering coughs and sneezes

Ongoing specialized medical care or needs specific medical

supplies Ongoing supervision needs or support for maintaining

independence

Difficulty accessing transportation

Economic barriers

Unstable employment or inflexible working conditions

Social or geographic isolation, like in remote and isolated

communities

Insecure, inadequate, or non-existent housing conditions.

If possible, only leave your home for

medically necessary appointments Stay away from people who are sick

Avoid contact with others, especially those

who have travelled or been exposed to the

virus

If contact cannot be avoided, take the

following precautions: o keep at least 2 m between yourself

and the other people o give a friendly wave instead of a

handshake, kiss or hug

o keep interactions brief Remind others who are sick, or may have

been exposed to the virus, to stay away

Avoid crowds and large gatherings

Avoid cruises and non-essential travel

outside of Canada.

England


PHE

Shielding • Solid organ transplant recipients. • People with specific cancers:

people with cancer who are undergoing active

chemotherapy people with lung cancer who are undergoing radical

radiotherapy

people with cancers of the blood or bone marrow such

as leukaemia, lymphoma or myeloma who are at any

stage of treatment

Guidance is to stay at home as much as possible and shield until 6 July. It also advised that this is a

personal choice. If for example, a person is terminally ill or has a prognosis of less than 6 months to live, or

has some other special circumstances, that person

may decide not to stay at home. Other advice includes:

https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html

https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html

https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance


Page 35 of 61

Country /

setting

Protective

measure


people having immunotherapy or other continuing

antibody treatments for cancer people having other targeted cancer treatments which

can affect the immune system, such as protein kinase

inhibitors or PARP inhibitors

people who have had bone marrow or stem cell

transplants in the last 6 months, or who are still taking immunosuppression drugs.

• People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD

• People with rare diseases that significantly increase the risk of infections (such as SCID, homozygous sickle cell)

• People on immunosuppression therapies sufficient to

significantly increase risk of infection • Women who are pregnant with significant heart disease,

congenital or acquired.

All children and young people currently identified as clinically

extremely vulnerable, and advised to shield, should continue to do

so until 31 July, when the government will pause shielding for

everyone. It is acknowledged that the risk is lower in children so

it is advised that children and young people up to the age of 18,

consult their paediatric specialist or GP to determine the most

appropriate care. Children with conditions including asthma,

diabetes, epilepsy and kidney disease, as well as children who

receive specialist care in hospitals may still be considered clinically

extremely vulnerable following a consultation with their doctor.

This includes those receiving cancer care or those at risk of severe

infection due to an immunodeficiency.

• meet in a group of up to 6 people outdoors, including people from different households, while

maintaining strict physical distancing

• no longer observe physical distancing with other members of their household

• in line with the wider guidance for single adult households (either an adult living alone or with

dependent children under 18) in the general population, form a ‘support bubble’ with one

other household. All those in a support bubble

will be able to spend time together inside each other's homes, including overnight, without

needing to physically distance.

For people living a person who falls in this group:

Minimise the time other people living with you

spend in shared spaces, such as kitchens,

bathrooms and sitting areas, and keep shared spaces well ventilated.

You no longer need to observe physical

distancing with other members of your household.

If you share a toilet and bathroom with others,

they should be cleaned every time after use (for example, wiping surfaces you have come into

contact with). Consider drawing up a rota for

bathing, with you using the facilities first. If you share a kitchen with others, avoid using it

while they are present. If you can, take your

meals back to your room to eat. If you have one, use a dishwasher to clean and dry the family’s

used crockery and cutlery. If this is not possible,

wash them using your usual washing-up liquid and warm water and dry them thoroughly. If you


Page 36 of 61

Country /

setting

Protective

measure


are using your own utensils, use a separate tea towel for drying these.

Everyone in your household should regularly

wash their hands, avoid touching their face and

clean frequently touched surfaces.

England

Guidance

provided by:

PHE

Social

distancing

Aged 70 or older (regardless of medical conditions)

Under 70 with an underlying health condition listed below

(that is, anyone instructed to avail of influenza vaccination

each year on medical grounds):

o Chronic (long-term) mild to moderate respiratory diseases, such as asthma, COPD, emphysema or

bronchitis

o Chronic heart disease, such as heart failure o Chronic kidney disease

o Chronic liver disease, such as hepatitis o Chronic neurological conditions, such as Parkinson’s

disease, motor neurone disease, multiple sclerosis (MS) or cerebral palsy

o Diabetes

o A weakened immune system as the result of certain conditions, treatments like chemotherapy, or medicines

such as steroid tablets o Being seriously overweight (BMI of 40 or above).

Those who are pregnant.

Advice people in this group is to strictly follow advice

aimed at the general public, which is:

you can meet in groups of up to 2 households

(anyone in your support bubble counts as 1

household) in any location - public or private,

indoors or outdoors. You do not always have to meet with the same household - you can meet

with different households at different times. However, you should physically distance from

anyone not in your household or bubble. This change also does not affect the support you

received from carers

when you are outside you can continue to meet

in groups of up to 6 people from different households, following physical distancing

guidelines those who have been able to form a support

bubble (i.e. those in single adult households) can

continue to have close contact as if they live with

the other people in the bubble, but you should not change who you have formed a support

bubble with you can stay overnight from your home with

your own household or support bubble, or with

members of one other household (where you need to keep physical distancing)

Those who want to go out to help a vulnerable person,

can do so unless they have coronavirus symptoms,

https://www.gov.uk/coronavirus


Page 37 of 61

Country /

setting

Protective

measure


however mild and whenever possible to ensure social

distancing and hand hygiene is maintained.

Finland


Finish

Institute for Health and

Welfare

Persons over 70 years of age.

The risk of severe coronavirus infection may be increased

by those underlying diseases that significantly impair lung or heart function or the body’s resistance, such as:

o Severe heart disease o Lung disease that is not clinically stabilised

Diabetes that involves organ damage

Chronic liver or kidney failure

Diseases that weaken the immune system, such as

leukaemia or lymphoma that is currently undergoing

cytostatic treatment (not maintenance therapy) Medication which significantly weakens the immune system

(e.g. high-dosage cortisone therapy).

Other factors that generally impair lung functioning and may

increase the health risk of a coronavirus infection include morbid

obesity (BMI over 40) and daily smoking.

Avoid close contact with other people as far as

possible. This means that they can go out, provided they practice social distancing.

Shopping is permitted if crowds can be avoided. If a visit to someone in this risk group is

essential, handshakes, hugging and other close

contact should be avoided unless essential for

care or treatment reasons. It is important that all visitors use a scarf or other protection for their

nose and mouth. People close to those over 70 and in risk groups have been urged to consider

the potential risk of infection via their other

contacts.

Risk groups should protect themselves from the

health hazards of hot weather: Consider installing a portable air conditioner or

air source heat pump.

Avoid using a fan in common areas where more

than one person is present. It is particularly important to avoid using a fan in confined

spaces with poor ventilation. If using a fan, it is

a good idea to make sure that the ventilation in the space works efficiently and set the fan so

that it does not blow air from one person to another.

For older people and in particular those over 70,

advice is to follow the general guidelines to reduce the risk of infection, keep in touch with family and friends

but avoid contact with others and when shopping to avoid peak hours and do not spend more time in

stores than necessary.

https://thl.fi/en/web/infectious-diseases/what-s-new/coronavirus-covid-19-latest-updates





Page 38 of 61

Country /

setting

Protective

measure


Germany

Guidance

provided by: Robert Koch

Institut and the Federal

Ministry of Health

• Older people (with a steadily increasing risk of severe course from around 50–60 years)

• Very obese

• Smokers • People with certain medical conditions:

o of the cardiovascular system (e.g. coronary heart disease and high blood pressure)

o chronic diseases of the lungs (e.g. COPD) o Patients with chronic liver disease)

o Patients with diabetes mellitus

o Patients with cancer.

Patients with a weakened immune system (e.g. due to a disease

that is associated with an immunodeficiency or by taking medication that can influence and reduce the immune defence,

such as cortisone, on a regular basis).

Stay at home wherever possible

Have family or neighbours take care of supplies

Reduce personal contact to the bare minimum

and, if you do have to see people, keep your distance (1.5 metres)

It is also recommended to wear a mask in public

spaces.

Ireland


Health

Protection Surveillance

Centre and Department

of Health

‘Cocooning’ People aged ≥ 70 years

Solid organ transplant recipients

People with specific cancers:

o people with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer

o people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any

stage of treatment

o people having immunotherapy or other continuing antibody treatments for cancer

o people having other targeted cancer treatments which can affect the immune system, such as protein kinase


o people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking

immunosuppression drugs. People with severe respiratory conditions including cystic

fibrosis, severe asthma, pulmonary fibrosis/ lung fibrosis/

interstitial lung disease and severe COPD

If you choose to go for outside for exercise you

should:

• strictly adhere to 2m social distancing measures • avoid close face-to-face contact

• avoid touching people or surfaces

• wash your hands on returning home

If you choose to go for a drive, you should adhere to

the following measures:

• don’t share the journey with anyone who is not

cocooning with you • strictly adhere to the 2m social distancing

measures when out

• wash your hands on returning home

The use of public transport is to be avoided if possible,

should only be used in non-peak times and where a

physical distance of 2m can be maintained. Face

https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/nCoV_node.html

https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/nCoV_node.html

https://www.zusammengegencorona.de/en/



https://www.hpsc.ie/a-z/respiratory/coronavirus/




https://www.gov.ie/en/campaigns/c36c85-covid-19-coronavirus/

https://www.gov.ie/en/campaigns/c36c85-covid-19-coronavirus/


Page 39 of 61

Country /

setting

Protective

measure


People with rare diseases and inborn errors of metabolism

that significantly increase the risk of infections (such as SCID, homozygous sickle cell)

People on immunosuppression therapies sufficient to

significantly increase risk of infection

Women who are pregnant with significant heart disease,


coverings should be used, and wash your hands on

returning home.

If you need to attend essential services for example

healthcare appointments and have no other means of

attending other than getting a taxi, the following

measures can be taken to minimise risk of spread:

• indicate to the driver in advance that you are

cocooning • maintain strict hand hygiene

• the use of face coverings for both passenger and driver

• keeping as much distance as is practical

If you choose to go shopping, it is best to adhere to

the following measures:

• attend shops that provide dedicated hours for those who are cocooning which will enable you

to do your shopping in a safer way • ideally wear a face covering

• strictly adhere to the 2m social distancing

measures when out • wash your hands on returning home.

You can also have a small number of visitors to your

home (outdoors as much as possible), ideally from a

core group of family or friend who are aware of your

circumstances and willing to adhere to protective

measures while you cocoon. In addition, visitors must

not visit you if they are unwell, should keep at least

2m away from you, wash their hands with soap and

water for at least 20 seconds on arrival to your house

and should wear face coverings.


Page 40 of 61

Country /

setting

Protective

measure


If you choose to visit other people’s homes, tell them

in advance that you are coming, make sure that no

one in the household is unwell with COVID-19, ideally

wear a face covering, strictly adhere to the 2m social

distancing measures and wash your hands on

returning home. Make the visits outdoors as much as

possible.

You may also attend a funeral of a close relative or

friend, but as with any gathering of people, it is

important that you maintain strict physical distancing,

strictly adhere to 2m social distancing measures, wear

a face covering, avoid close face-to-face contact,

avoid touching people and wash your hands on

returning home.

In general, group activities or group sports should be

avoided at this time.

Those who are working remotely should continue to

do so and only return to the workplace if appropriate

safety measures are in place.

New

Zealand

Guidance provided by

Ministry of Health and

Government of New

Zealand

None People over 70

People with underlying medical conditions such as:

o serious respiratory disease such as chronic lung disease

or moderate to severe asthma

o serious heart conditions o immunocompromised conditions*

o severe obesity — a BMI of 40 or higher o diabetes

o chronic kidney disease o people undergoing dialysis

o liver disease.

At Level 1:

Stay vigilant when out and about Maintain physical distance from others if you

possible Keep up good hygiene practices



https://covid19.govt.nz/




Page 41 of 61

Country /

setting

Protective

measure


*Many conditions can cause a person to be immunocompromised, including:

o cancer treatment

o smoking related illness o bone marrow or organ transplantation

o haematologic neoplasms o immune deficiencies

o poorly controlled HIV or AIDS o prolonged use of corticosteroids and other immune

weakening medications such as disease-modifying anti-

rheumatic drugs o people in aged care facilities (updated 15 May).

Other factors contributing to risk

o ethnicity o smoking

o obesity (BMI of 40 or higher)

o pregnancy (pregnant women in their 3rd trimester).

Northern

Ireland

Guidance

provided by: Public

Health Agency and

Government

of Northern Ireland (NI

Direct)

Shielding Extremely vulnerable people:

• Solid organ transplant recipients • People with specific cancers:

People with cancer and are undergoing active

chemotherapy

People with lung cancer and are having radical

radiotherapy People with cancers of the blood or bone marrow such as

leukaemia, lymphoma or myeloma who are at any stage

of treatment People having immunotherapy or other continuing

antibody treatments for cancer

People having other targeted cancer treatments which

can affect the immune system, such as protein kinase


People who are following the shielding advice are able

to meet up to 6 people outside of their home, as long

as physical distancing is strictly observed.

If you are shielding alone, you can also form a support

bubble with 1 other household. Where you form a

bubble:

physical distancing is not required with the other household in your bubble; this will allow you to

visit, stay over and spend more time with the second household

the second household can be of any size

both households should not be part of more than 1 bubble and should continue to physically

distance outside the bubble. When outside:

should take extra care to minimise contact with others by keeping 2 m apart, when spending

https://www.publichealth.hscni.net/news/covid-19-what-situation-northern-ireland



https://www.nidirect.gov.uk/articles/coronavirus-covid-19-overview-and-advice




Page 42 of 61

Country /

setting

Protective

measure


People who have had bone marrow or stem cell

transplants in the last 6 months, or who are still taking immunosuppression drugs

• People with severe respiratory conditions including all cystic

fibrosis, severe asthma and severe COPD • People with rare diseases and inborn errors of metabolism


• People on immunosuppression therapies sufficient to significantly increase risk of infection

• Women who are pregnant with significant heart disease,

congenital or acquired • People with Motor Neurone Disease

• People undergoing renal dialysis • People who have had a splenectomy.

Other relevant conditions: A person’s immunity remains compromised for some time

after finishing chemotherapy. If you have completed

chemotherapy in the last 3 months, please contact your care team to discuss your circumstances.

People with metastatic cancer in the lungs could also be

more vulnerable and therefore at highest clinical risk from COVID-19.

Those who are currently on targeted therapies for lung

cancer are also classed as the highest clinical risk.

time outdoors (i.e. not in other buildings, households or enclosed spaces).

should remain with members of your own

household. If you live alone, you can spend time outdoors with one person from another

household (ideally the same person each time). should remain vigilant when leaving home:

washing your hands regularly, maintaining social distance and avoiding gatherings of any size.

should not attend any gatherings, including

gatherings of friends and families in private spaces, for example, parties, weddings and

religious services. should strictly avoid contact with anyone who is

displaying symptoms of COVID-19 (a new

continuous cough, a high temperature, or a loss of, or change in, sense of taste or smell).

Northern Ireland


Public Health

Agency and Government

Self-isolate Vulnerable groups Over the age of 70

Under 70 with an underlying health condition listed below:

o Chronic (long-term) mild to moderate respiratory

diseases, such as asthma, COPD, emphysema or

bronchitis o Chronic heart disease, such as heart failure

o Chronic kidney disease o Chronic liver disease, such as hepatitis

Everyone should be staying at home and

following social distancing measures. Older people and vulnerable people, including

those with underlying health conditions and

pregnant women should be particularly strict

when following them.






Page 43 of 61

Country /

setting

Protective

measure


of Northern Ireland (NI

Direct)

o Chronic neurological conditions, such as Parkinson’s disease, multiple sclerosis (MS), a learning disability or

cerebral palsy

o Diabetes o A weakened immune system as the result of conditions

such as HIV and AIDS or medicines such as steroid tablets or chemotherapy

o Being seriously overweight (BMI of 40 or above). Those who are pregnant.

Norway


Norwegian

Institute of Public

Health

Protective self-

separation

People at moderate (clinically vulnerable) / high risk (clinically extremely vulnerable):

Over 80 years of age

Residents of nursing homes

Age 66–80 years with 1 of the following chronic diseases,

OR age 50–65 years with 2 or more of the following chronic diseases:

o cardiovascular disease (other than well-regulated high

blood pressure) o morbid obesity (BMI ≥ 30 kg/m2 in combination with

weight-related diseases or BMI ≥ 40 kg/m2) o diabetes

o chronic kidney disease and kidney failure o chronic lung disease (other than well-regulated asthma)

o chronic liver disease

o in immunosuppressive therapy such as chemotherapy, radiation therapy and immunosuppressive therapy in

autoimmune diseases. Severe health condition, regardless of age*:

o people with active cancer, ongoing or recently

discontinued treatment for cancer (especially

immunosuppressive therapy, radiation therapy to the lungs or chemotherapy). Leukaemia has a higher risk

than other types of cancer o neurological or muscular disease with impaired

coughing strength or lung function (e.g. ALS)

Advice for people in this group depends on whether transmission is low or widespread in their

communities.


Increase social distancing You can be with your closest circle as normal, and

travel and socialise with others as long as:

You and your closest circle are particularly

careful to follow general advice, keeping a safe distance and follow good hand hygiene and

cough etiquette. You limit your number of close contacts.

You avoid crowded places (e.g. public transport,

shopping malls) or only go to such places when

they are less busy.

Workplace planning and adjustment may be

appropriate.

Widespread transmission or outbreaks in your

community:

Social shielding To avoid infection, you should withdraw during this

period. You can go outside and maintain normal








Page 44 of 61

Country /

setting

Protective

measure


o congenital immunodeficiency in an unstable phase that carries the risk of severe respiratory tract infections

o blood disorders that include cells or organs that are

important for the immune system o bone marrow transplant or organ transplant

o HIV infection with low CD4 counts o significant renal impairment or significantly impaired

liver function o other, assessed by a physician.

*Some serious health conditions in this list based on a precautionary principle, although at present there are no studies indicating a higher risk of severe progression for the diseases.

contact with your closest circle as long if you follow the advice in the yellow box and in addition:

Keep a greater distance from others (preferably

2m) than your closest circle.

Ask others to help you with necessary

purchases. Your closest circle should also limit their social

contact. If not, you should keep a safe distance

to them. If this is not possible, it might be necessary to consider other temporary housing

arrangements.

If workplace adjustment or remote working is

impossible, sick leave should be considered.

Norway


Norwegian Institute of

Public Health

Protective

self-

separation

People at slightly increased risk:

age 65–80 years (especially over 70)

age 50–65 years with one of the following chronic diseases:

o cardiovascular disease (other than well-regulated high

blood pressure) o morbid obesity (BMI ≥ 30 kg/m2) in combination with

weight-related diseases or BMI ≥ 40 kg/m2) o diabetes

o chronic kidney disease and kidney failure o chronic lung disease (other than well-regulated asthma)

o chronic liver disease

o in immunosuppressive therapy such as chemotherapy, radiation therapy and immunosuppressive therapy in

autoimmune diseases

People under 50 years of age have a lower risk of developing

severe COVID-19 disease. However, some people with poorly-regulated chronic conditions or a combination of several chronic

diseases might be at increased risk.

Advice for people in this group depends on whether

transmission is low or widespread in their

communities.


Live like others You can generally live like the rest of the population,

travel, work and attend events, but be particularly careful to follow the general advice:

Keep the recommended distance to people,

apart from your closest family and friends

Remember hand hygiene and cough etiquette

Stay home when you are ill

Avoid being with people who are sick.

Consider whether you will be able to follow these measures before travelling or participating in social

activities.






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Widespread transmission or outbreaks in your community:

Increase social distancing You can be in normal contact with your closest circle, and travel and socialise with others as long

as: You and your closest circle are particularly

careful to follow general advice, keeping a safe distance and follow good hand hygiene and

cough etiquette.

You limit your number of close contacts

You avoid crowded places (e.g. public transport,

shopping malls) or only go to such places when they are less busy.

Workplace planning and adjustment may be appropriate.

Scotland

Guidance

provided by: Health

Protection

Scotland and Scottish

Government

‘Shielding’ Highest risk group:

• Solid organ transplant recipients. o Includes people who have had a transplant of heart,

lung, stomach or other part of intestine, liver and kidney. People will be in this group because they need to take

medications to prevent rejection of the transplanted

organ. • People with specific cancers:

o People with cancer who are undergoing active chemotherapy or have had radical radiotherapy for lung

cancer

o People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage

of treatment o People having immunotherapy or other continuing

antibody treatments for cancer

At home:

Physically distancing with those of the same

household is no longer require (10 July) Outside:

stop physically distancing from the people they

live with use indoor toilets in other people’s houses when

visiting them outdoors

meet up to 8 people outdoors, from 2 other

households, in a single day

travel as far as they want from their house,

book self-catering accommodation or travel to a

second home - only to stay over with people they live with at home

Meeting family and friends from another household:

https://www.hps.scot.nhs.uk/a-to-z-of-topics/covid-19/#guidelines



https://www.gov.scot/collections/coronavirus-covid-19-guidance/



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o People having other targeted cancer treatments which can affect the immune system, such as protein kinase


o People who have had bone marrow or stem cell transplants in the last 6 months. Or people who are still

taking immunosuppression drugs. • People with severe respiratory conditions including all cystic

fibrosis, severe asthma and severe COPD, severe bronchiectasis and pulmonary hypertension:

o All patients with cystic fibrosis

o Severe asthma means being on regular inhalers AND long term steroid tablets, e.g. prednisolone, OR regular

injections to control your asthma o Severe COPD - means being too breathless to walk 100

yards, having 2 or more lung infections per year or

requiring oxygen to help with breathing. This is usually anyone who has been on several different inhaler

medications in the last year. This must include 2 long acting preventers (Long Acting Beta Agonists and Long

Acting Anti-Muscarinic Antagonists) and a steroid inhaler o On home oxygen for your lung condition.

• People with rare diseases including all forms of interstitial

lung disease/sarcoidosis. Also, includes inborn errors of metabolism that significantly increase the risk of infections

(such as SCID, homozygous sickle cell disease) o There are many conditions classed as a rare disease. Not

everyone with a rare disease will be at a higher risk of

severe illness from COVID-19. o Your clinician will know if you should be in the highest

risk group and will make sure that you are added. If you are added to this group you will receive a letter telling

you what to do.


significantly increase risk of infection or who have had their spleens removed:

Form an exclusive ‘bubble’ with another

household and visit that household and stay over without physical distancing.

Children aged 11 and under who live with someone

who is shielding can play with other children aged 11

or under, without physical distancing.

Children and young people who have been advised to

shield have now been asked to speak with their GP or

clinician to assess whether they need to continue to

shield.


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o Patients on high dose corticosteroids (equivalent to Prednisolone 20mg or more) for 4 weeks or more

o Patients on specific single therapies, for example

Cyclophosphamide, however, clinical judgement is needed to determine if medications would indicate

highest risk. o Patients on lower dose of corticosteroids (equivalent to

Prednisolone 5mg per day for 4 weeks or more), in combination with other disease modifying medication

o Patients on several different disease modifying

medications taking into account their other chronic medical conditions (Patients on a single Disease

Modifying medications (DMARD) or Biologic such as Methotrexate, Azathioprine, Ciclosporin, Leflunomide

plus others, would not be considered automatically in

the highest risk group if they are otherwise healthy, but should be decided by a specialist or GP if not sure).

People who are pregnant with significant heart disease,

congenital or acquired People who are receiving renal dialysis treatment.

Scotland


Health Protection

Scotland

and Scottish Government

Social

distancing

High risk group:

People over the age of 70 are considered vulnerable, even if they

do not have an underlying health condition. This also applies to those who are pregnant.

Others considered vulnerable include people who have:

Chronic (long-term) respiratory diseases, such as asthma,

COPD, emphysema or bronchitis

Chronic heart disease, such as heart failure

Chronic kidney disease

Chronic liver disease, such as hepatitis

Chronic neurological conditions, such as Parkinson’s disease,

motor neurone disease, MS, a learning disability or cerebral palsy

No specific advice besides follow general

advice







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Diabetes

Problems with your spleen – for example, sickle cell disease

or if you have had your spleen removed A weakened immune system as the result of conditions such

as HIV and AIDS, or medicines such as steroid tablets or

chemotherapy

Being seriously overweight (BMI of 40 or above)

Singapore


Ministry of

Health and Government

of Singapore

Protective self-

separation

Persons who are aged 60 and above Patients who are immunocompromised or have concurrent

medical conditions such as obesity (BMI > 31), hypertension, diabetes, chronic heart and lung diseases, kidney diseases

on dialysis, hypercoagulable states, cancer, or patients on

drugs that cause immunosuppression.

Avoid social gatherings and crowded places as

far as possible, and to only go out for essential purposes (e.g. work, purchase food and

supplies) Families may also visit their parents or

grandparents, capped at 2 persons per

household per day

Grandparents can provide childcare on a daily

basis but physical distance to parents must be maintained

Face shields may be worn for people who have

health conditions that may result in breathing or other medical difficulties when a mask is worn

for a prolonged period of time. For all others, face masks must be worn.

Sweden

Guidance

provided by:

The Public Health

Agency of Sweden

Social

distancing

Older age combined with pre-existing medical conditions such as:

High blood pressure

Cardiovascular disease

Pulmonary disease

Diabetes.

People with asthma, allergies, or kidney disease may have a higher risk of severe illness, but the evidence is unclear.

Any condition that makes a person vulnerable to an infectious

diseases. For example, problems with the immune system, people should seek advice from their doctor about how to manage their

Limit their physical close contact with others and

completely avoid public transportation.

Avoid travelling by bus, tram or subway,

shopping in supermarkets, or visiting venues where many people gather at any one time.

Instead, ask friends, family or neighbours to do

your shopping etc. While remaining at home, you may still go out

for walks.

https://www.moh.gov.sg/covid-19

https://www.moh.gov.sg/covid-19

https://www.gov.sg/features/covid-19

https://www.gov.sg/features/covid-19

https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/





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condition and how to decrease the risks associated with COVID-19.

According to a report published on 20 April by the Swedish

National Board of Health and Welfare (“Socialstyrelsen”), people that are most at risk are those:

Advanced age, 70 years and older

Obesity, with a BMI over 40

Cancer or with ongoing or recently completed cancer

treatment

Neuromuscular disorders such as Parkinson's, MS or ALS

with involved muscular functioning Intellectual impairment and disability (multifunctional

impairment)

At least 2 of the following: cardiovascular disease (angina,

heart failure, stroke), hypertension, diabetes with complications, chronic kidney disease and kidney failure,

chronic lung disease (other than asthma) and chronic liver disease.

People with immunodeficiency diseases, diseases, or residual

conditions after diseases that seriously affect certain organ

functions, spinal cord injury with a need for continuous respiratory support, as well as treatment that may impair

the body's defence against viral infections. The combination of several risk factors increases the risk

further.

Switzerland

Guidance

provided by: Federal

Office of

Public Health

Protective

self-separation

Those over the age of 65

Those who have one of the following conditions in particular:

o High blood pressure

o Diabetes o Cardiovascular disease

o Chronic respiratory diseases o Conditions and therapies that weaken the immune

system.

Cancer

stay at home

avoid gatherings

have a friend or neighbour do the shopping for

you and leave it outside the door

adults should only visit their parents if they need

assistance that they can’t get elsewhere although the Federal government permits visits

to care homes for the elderly in principle, it is a

matter for the cantons to set the rule.

https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov.html





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Severe obesity (BMI of 40 or over).

An additional list is provided in the COVID ordinance 2 document:

High blood pressure (hypertension):

Arterial hypertension with end-organ damage

Therapy-resistant arterial hypertension

Cardio-vascular diseases: General criteria: o Patients with dyspnea of functional class NYHA ≥ II and

NT per BNP > 125 pg/ml

o Patients with 2 cardiovascular risk factors (one of which is diabetes or arterial hypertension)

o Prior stroke and/or symptomatic vasculopathy

o Chronic renal insufficiency (Stage 3, GFR <60ml/min) Other criteria:

Coronary heart disease: o Myocardial infarction (STEMI and NSTEMI) in the

past 12 months

o Symptomatic chronic coronary syndrome despite medical treatment (irrespective of any prior

revascularisation) Disease of the heart valves:

o Moderate or serious stenosis and/or regurgitation in addition to meeting at least one general criterion

o Any surgical or percutaneous valve replacement in

addition to meeting at least on general criteria Cardiac insufficiency:

o Patient with functional class NYHA ≥ II-IV or NT-Per BNP > 125pg/ml despite medical treatment for any

LVEF (HFpEF, HFmrEF, HFrEF)

o Cardiomyopathy with any cause o Pulmonary arterial hypertension

Arrhythmia:

grandparents over 65 years or with an

underlying medical condition are allowed to look after grandchildren, except when either person is

ill, but are advised to keep a distance from

parents. work can resume.

https://www.admin.ch/opc/en/classified-compilation/20200744/index.html#app6

https://www.admin.ch/opc/en/classified-compilation/20200744/index.html#app6


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o Auricular fibrillation with a CHA2DS2-VASc score of at least 2 points

o Prior implant of pacemaker (incl. ICD and/or CRT

implantation) in addition to meeting one general criterion

Adults with congenital heart disease o Congenital heart disease according to the individual

assessment of the attending cardiologist Chronic respiratory diseases:

Chronic obstructive lung diseases GOLD Grade II-IV

Pulmonary emphysema

Unmanaged asthma, in particular serious bronchial

asthma

Interstitial lung diseases

Active lung cancer

Pulmonary arterial hypertension

Pulmonary vascular disease

Active sarcoidosis

Cystic fibrosis

Chronic lung infections (atypical mycobacteriosis,

bronchiectasis, etc.) Ventilated patients

Diabetes:

o Diabetes mellitus, with long-term complications or a HbA1c von > 8%

Diseases/Therapies that weaken the immune system: o Serious immunosuppression (e.g. CD4+< 200µl)

o Neutropenia ≥1 week

o Lymphocytopenia <0.2x109/L o Hereditary immunodeficiencies

o Use of medication that suppresses the immune defences (such as long-term use of glucocorticoids, monoclonal

antibodies, cytostatics, etc.)

o Aggressive lymphomas (all entities) o Acute lymphatic leukaemia


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o Acute myeloid leukaemia o Acute promyelocytic leukaemia

o T-cell prolymphocytic leukaemia

o Primary lymphomas of the central nervous system o Stem cell transplantation

o Amyloidosis (light-chain (AL) amyloidosis) o Aplastic anaemia undergoing immunosuppressive

treatment o Chronic lymphatic leukaemia

o Asplenia / splenectomy

o Multiple myeloma o Sickle-cell disease

Cancer: Cancer undergoing medical treatment

Obesity:

Patients with a body-mass index (BMI) of 40 kg/m2 or

more

United States

Guidance

provided by:

Center for Disease

Control

Protective self-

separation

At increased risk: • Older adults (no specific age)

• People with underlining medical conditions: o Chronic kidney disease

o COPD

o Immunocompromised state (weakened immune system) from solid organ transplant

o Obesity (BMI of 30 or higher) o Serious heart conditions, such as heart failure, coronary

artery disease, or cardiomyopathies

o Sickle cell disease o Type 2 diabetes mellitus

o Children who are medically complex, who have neurologic, genetic, metabolic conditions, or who have

congenital heart disease.

Might be at an increased risk:

Asthma (moderate-to-severe)

Those at increased risk are advised to stay home if possible. Limit interactions with other people as

much as possible and to take precautions to prevent getting COVID-19 when interacting with others. This

includes wearing a mask when it is difficult to stay at

least 6 feet apart from others outside their household, and avoiding others who are not wearing

a mask or asking those in close proximity to wear a mask.

No specific advice is given for those that might be at

an increased risk.

https://www.cdc.gov/coronavirus/2019-ncov/index.html




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Cerebrovascular disease (affects blood vessels and blood supply to the brain)

Cystic fibrosis

Hypertension or high blood pressure Immunocompromised state from blood or bone marrow

transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines

Neurologic conditions, such as dementia Liver disease

Pregnancy

Pulmonary fibrosis (having damaged or scarred lung tissues) Smoking

Thalassemia (a type of blood disorder) Type 1 diabetes mellitus

Wales

Guidance

provided by: the Welsh

Government

Shielding Solid organ transplant recipients

People with specific cancers:

o People with cancer who are undergoing active

chemotherapy or radical radiotherapy for lung cancer o People with cancers of the blood or bone marrow such as

leukaemia, lymphoma or myeloma who are at any stage of treatment

o People having immunotherapy or other continuing

antibody treatments for cancer o People having other targeted cancer treatments which

can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

o People who have had bone marrow or stem cell

transplants in the last 6 months, or who are still taking immunosuppression drugs.

People with severe respiratory conditions including all cystic

fibrosis, severe asthma and severe COPD People with severe single organ disease (e.g. Liver, Cardio,

Renal, Neurological)

Things you should be doing to stay safe

consider whether you wish to form an extended household and speak with your friends and

family about how this could work in practice while keeping you safe.

keep 2 m or 3 steps away from other people

outside your home and within your home. leave your home to undertake exercise if you

want to. You can leave your home to exercise outside as many times as you want to but stay

local and try to avoid busy places so you can

keep 2 m or 3 steps away from other people. meet outside with people from another house

locally if you want to but always keep 2 m or 3 steps away.

regularly wash your hands with soap and water

for 20 seconds. ask neighbours, friends and family to bring you

food and medicine. contact your local supermarket for priority online

shopping.

https://gov.wales/guidance-on-shielding-and-protecting-people-defined-on-medical-grounds-as-extremely-vulnerable-from-coronavirus-covid-19-html



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People with rare diseases and inborn errors of metabolism



significantly increase risk of infection

Pregnant women with significant heart disease, congenital or

acquired. Children up to the age of 18 with significant heart disease,


keep in touch with people using the phone, Internet and social media.

use telephone or online services to contact your

GP, pharmacy or other day-to-day services. contact your local council if you have no one

who can help you. Things you should not be doing to stay safe

Do not get close to anyone who is showing signs of coronavirus. This could be any or all of the

following: high temperature (> 37.8 °C), a new

and continuous cough, a loss of/or change to your sense of smell or taste.

Do not attend any gatherings indoors. This includes gatherings of friends and families – e.g.

in family homes or weddings and religious

services. Do not go out shopping. When arranging food

deliveries, these should be left at the front door. Do not go to your GP, pharmacy or hospital

without phoning first. You should speak to your pharmacy about how you can get your medicine.

Do not go to your place of work if this is outside

your home. You should only work if you can work from home.

Do not go to school. You should learn from home. Children who are at high risk are advised

not to attend school but should continue to learn

from home. You should not go to your normal place of work

– you will need to work at home until the 16 August 2020, if you can do so.

Last updated 06/07/2020 15.00 GMT


Page 55 of 61

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2. Health Protection Surveillance Centre (HPSC). Guidance for protecting people over 70 and extremely medically vulnerable people V1.3. Dublin: 2020.Available from: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/vulnerablegroupsguidance/COVID-19%20Guidance%20for%20extremely%20medically%20vulnerable%20groups.pdf.

3. Health Protection Surveillance Centre (HPSC). Visitors at home during the COVID-19 Pandemic: Health Protection Surveillance Centre 2020 [Available from: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/vulnerablegroupsguidance/COVID-19%20visits%20to%20home.pdf]. 15 June20

4. Health Protection Surveillance Centre (HPSC). COVID-19 Guidance on visitations to Residential Care Facilities: Health protection Surveillance Centre; 2020 [Available from: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/vulnerablegroupsguidance/COVID-19%20Guidance%20on%20visiting%20residential%20care.pdf]. 15 June20

5. Public Health England. Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19 England: Public Health England; 2020 [Available from: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19]. 23 March 2020

6. Health and Social Care Secretary. Plans to ease guidance for over 2 million shielding: UK Government; 2020 [Available from: https://www.gov.uk/government/news/plans-to-ease-guidance-for-over-2-million-shielding]. 29 June2020

7. NHS Digital. Coronavirus (COVID-19): Shielded patients list: NHS Digital; 2020 [Available from: https://digital.nhs.uk/coronavirus/shielded-patient-list]. 14 May 2020

8. Public Health England. Guidance on social distancing for everyone in the UK: Public Health England; 2020 [Available from: https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults]. 23

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https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/vulnerablegroupsguidance/COVID-19%20visits%20to%20home.pdf



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https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults




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11. Northern Ireland Direct. Guidance on shielding for extremely vulnerable people: Government of Northern Ireland; 2020 [Available from: https://www.nidirect.gov.uk/articles/guidance-shielding-extremely-vulnerable-people]. 29 June2020

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https://www.nidirect.gov.uk/articles/guidance-shielding-extremely-vulnerable-people

https://www.nidirect.gov.uk/articles/guidance-shielding-extremely-vulnerable-people

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24. Depatment of Health. 3-Step Framework for a COVIDSafe Australia: Australian Government; 2020 [Available from: https://www.health.gov.au/resources/publications/3-step-framework-for-a-covidsafe-australia]. 12 May2020

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27. Finnish Government. Government updates policies on border issues, remote working and recommendations for persons over 70 years of age: Finnish Government; 2020 [Available from: https://valtioneuvosto.fi/en/-/10616/government-updates-policies-on-border-issues-remote-working-and-recommendations-for-persons-over-70-years-of-age]. 23 June2020

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29. Sutton D, Fuchs K, D’Alton M, Goffman D. Universal Screening for SARS-CoV-2 in Women Admitted for Delivery. New England Journal of Medicine. 2020.

30. Gajbhiye R, Modi D, Mahale S. Pregnancy outcomes, Newborn complications and Maternal-Fetal Transmission of SARS-CoV-2 in women with COVID-19: A systematic review. medRxiv; 2020.

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